Does preoperative treatment with a gonadotropin-releasing hormone agonist improve the outcome of endometrial resection?

Study Objective. To verify if more favorable long-term results of endometri al resection can be obtained with preoperative gonadotropin-releasing hormo ne (GnRH) agonist treatment. Design. Multicenter, randomized, controlled trial (Canadian Task Force clas sification I). Setting. Tertiary care academic department. Patients. Sixty-three premenopausal women with established menorrhagia. Intervention. Eight weeks of goserelin depot treatment before endometrial r esection or immediate surgery in the early proliferative phase of the cycle . Measurements and Main Results. Variations in menstrual patterns and bleedin g scores as well as overall degree of satisfaction with treatment were dete rmined 1 year after endometrial resection. Mean +/- SD monthly pictorial bl ood loss-assessment chart scores in the second 6-month follow-up period wer e 26.9 +/- 31.6 in the goserelin group and 44.0 +/- 45.7 in the immediate s urgery group (mean difference 17.1 points, 95% CI -3.0 to +37.2, p = 0.09, unpaired t test). Respective amenorrhea rates were 34% (11/32) and 20% (6/2 0, p = 0.26, Fisher's exact test, 95% CI of difference -8% to +37%). Overal l satisfaction with treatment was 91% and 87%, respectively Conclusion. Administration of a GnRH agonist before endometrial resection i s advantageous for surgery but has a limited effect in terms of postoperati ve bleeding pattern and appears not to offer clear-cut long-term clinical b enefit.